Focus Groups

Medicaid Incentives for Prevention of Chronic Diseases Evaluation

OMB: 0938-1219

IC ID: 208112

Information Collection (IC) Details

View Information Collection (IC)

Focus Groups
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10477 Screener for focus group eligibility Attachment_4a_Focus Group_Screener_English_clean.docx No No Fillable Fileable
Form and Instruction CMS-10477 Participant contact release form for focus groups Attachment_4d_Participant_Contact_Release_Forms_English_clean.docx No No Fillable Fileable
Form and Instruction CMS-10477 Focus group consent form Attachment_4e_Consent_Form_English_clean.docx No No Fillable Fileable
Form and Instruction CMS-10477 Screener_Spanish_new_clean Attachment_8a_Screener_Spanish_new_clean.docx No   Fillable Fileable
Form and Instruction CMS-10477 Participant_Contact_Release_Forms_Spanish_new_clean Attachment_8d_Participant_Contact_Release_Forms_Spanish_new_clean.docx No   Fillable Fileable
Form and Instruction CMS-10477 Consent_Forms_Spanish_new_clean Attachment_8e_Consent_Forms_Spanish_new_clean.docx No   Fillable Fileable
Form and Instruction CMS-10477 Discussion guide for focus groups Attachment_4b_Round_1_and_2_Discussion_Guide.pdf No No Fillable Fileable

Health Health Care Services

 

880 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 880 880 0 0 0 0
Annual IC Time Burden (Hours) 613 613 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Focus group appointment reminder Attachment_4f_Reminder_Email_English_clean.docx 01/15/2014
Focus group recruitment flyer Attachment_4c_Recruitment_Flyer_Template_English_clean.docx 01/15/2014
Attachment_8b_Discussion Guide_Spanish_new_clean Attachment_8b_Discussion Guide_Spanish_new_clean.docx 01/15/2014
Attachment_8c_Recruitment_Flyer_Spanish_new_clean Attachment_8c_Recruitment_Flyer_Spanish_new_clean.docx 01/15/2014
Attachment_8f_Reminder_Email_Spanish_new_clean Attachment_8f_Reminder_Email_Spanish_new_clean.docx 01/15/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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